tbuckley/cabot-search huggingface dataset:
Abstract 13443: Clinical Outcomes Following Primary Prevention Implantable Cardioverter Defibrillator (ICD) Implantation Among Older Patients With Hypertrophic Cardiomyopathy (HCM)
Authors: Sarah A Goldstein, kevin kennedy, Daniel Friedman, Sana M Al-Khatib, Andrew Wang
Journal: Circulation (2022)

Introduction: The clinical benefit of primary prevention ICDs among older patients (age &gt; 65) with HCM is unclear. This analysis examined procedural complications and post-discharge outcomes among older patients with HCM following initial placement of a primary prevention ICD. Methods: The NCDR ICD Registry was queried to identify patients with HCM who received a primary prevention ICD between 2010-2016. Procedure-related adverse event rates were examined. Direct identifiers were used to link patients &gt; 65 years to CMS claims data. Cox proportional hazard models were used to assess clinical factors associated with post-discharge mortality and hospitalization for cardiac arrest/ventricular arrhythmia (VA). Kaplan Meier curves were generated to depict 5-year outcomes. Results: Of 5571 patients with HCM who were included, 1511 (27.1%) were &gt; 65 years old. Compared with patients &lt; 65 years of age, older patients with HCM were more likely to experience a procedure-related event (2.3% vs 1.5%, p=0.038) and procedure-related death (0.3% vs 0.1%, p=0.024). The variables most strongly associated with post-discharge mortality were older age (aHR 1.8, 95% CI 1.47-2.21), NYHA class (III/IV vs I/II aHR 2.17, 95% CI 1.57-2.98), and LVEF (LVEF &lt; 35% vs &gt;50% aHR 2.34, 95% CI 1.58-3.48; LVEF 36-50% vs &gt;50% aHR 2.98, 95% CI 2.02-4.4). For the endpoint of hospitalization for cardiac arrest/VA, history of NSVT at the time of device implantation (aHR 2.38, 95% CI 1.62-3.51) and NYHA class (NYHA class III/IV vs I/II aHR 1.84, 95% CI 1.22-2.78) were the strongest predictors. The event-free survival rates are shown ( Figure). Conclusions: Procedure-related complication and mortality rates were low, but they occurred more frequently among older patients. Further prospective investigation should focus on whether clinical factors, such as NYHA class and history of NSVT, may be useful in identifying older patients with HCM who are most likely to benefit from a primary prevention ICD.
Abstract 13554: Effect of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Heart Failure Patients With Reduced Ejection Fraction - Implications for Healthcare Resource Utilization
Authors: Atul Malhotra, Kate Cole, Anita Malik, Jean-Louis Pépin, Fatima H Sert Kuniyoshi, Peter Cistulli, Adam Benjafield, Virend K Somers
Journal: Circulation (2022)

Introduction: Obstructive sleep apnea (OSA) is common in heart failure, although the impact of OSA treatment remains unclear. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and heart failure with reduced ejection fraction (HFrEF). Methods: Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFrEF were used to measure the association of PAP adherence and a composite clinical outcome of hospitalization and emergency room (ER) visits. US Medicare defines PAP compliance as usage of the device for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met these criteria for all 4 90-day periods, while PAP non-adherent patients did not meet these criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels. Results: The study cohort consisted of 3,182 eligible patients (69.9% male, mean age 59.7 years) of whom 39% were considered adherent to PAP therapy (29% intermediate-adherent, 31% non-adherent). In the year after PAP prescription, after propensity score matching, PAP adherent patients had fewer hospital visits than non-adherent patients, driven by a 24% reduction in ER visits for adherent patients (Table 1a). These results remained consistent with inverse probability weighting and furthermore showed there were no statistically significant differences between intermediate-adherent and non-adherent patients for any outcome (Table 1b). Conclusions: Treating OSA with PAP therapy in patients with HFrEF is associated with a reduction in the composite outcome of hospitalization and ER visits, driven primarily by a reduction in ER visits. Consistent adherence to PAP therapy is required to realize these benefits.
Abstract 14135: Neighborhood Socioeconomic Status and Heart Failure or All-Cause Readmission Within a Safety-Net System
Authors: Diane Jeon, Yifei Ma, Anjali Thakkar, Matthew S Durstenfeld, Priscilla Hsue
Journal: Circulation (2022)

Introduction: Neighborhood socioeconomic status (NSES) independently predicts higher rates of heart failure (HF) readmission, but whether this is true in a safety-net system is uncertain. Methods: We conducted a retrospective EHR-based cohort study of adults with HF between 2001-2019 at a municipal safety-net hospital in SF using Fine-Gray survival models. Most recent residential addresses were geocoded. NSES index is a composite measure including income, education, employment, and housing scaled to the SF Bay Area as quintiles (1=lowest, 5=highest). Results: Among 2,507 individuals with index HF hospitalization, 179 (7.1%) were readmitted within 30 days for HF and 374 (14.9%) for any cause. Within 1 year, 639 (25.5%) were readmitted for HF and 1,185 (47.3%) for any cause. In unadjusted analyses, NSES is associated with HF readmission at 30 days (p=0.013) or 1 year (p=0.021) and all-cause readmission at 30 days (p=0.0015) or 1 year (p=0.0049). Adjusted for demographics, substance use, and comorbidities, Quintile 1 has 58% higher risk of HF readmission (HR=1.58, 95% CI 1.07-2.33, p=0.021) and 56% higher risk of all-cause readmission (HR=1.56, 95% CI 1.19-2.05, p=0.001) over 1 year than Quintile 5. Similarly, compared to Quintile 5, all quintiles have higher risk of all-cause readmission over 1 year from Quintile 2 (HR=1.53, 95% CI 1.16-2.03, p=0.003) to Quintile 4 (HR=1.50, 95% CI 1.10-2.03, p=0.010). Including GDMT prescription does not change these results. Conclusion: NSES is associated with a higher risk of HF and all-cause readmissions over 1 year in a safety-net hospital. Further studies should investigate NSES domains to identify interventions and address disparities.
Abstract 13104: Prognostic Value of a Progressive Decrease in Apoj-Glyc Levels in Patients Attending A&amp;E Departments With Suspected Acute Coronary Syndrome or Angina-Like Pain
Authors: Juan-Carlos C Kaski, Judit Cubedo, Nuria Lluch, Jose L Lopez-sendon, Diana Gorog, Isabel Antorrena, Pablo Avanzas, Pablo Herrero Puente, Alessandro Sionis, Jose R Gonzalez-Juanatey, Andrés Iñiguez, Alberto Cordero, Emmanuel Ako, Francisco Fernandez-Aviles, Felipe Atienza, Alejandro Recio-Mayoral, Lina Badimon
Journal: Circulation (2022)

Introduction: Reduced serum levels of glycosylated apolipoprotein J (ApoJ-Glyc) have been proposed as a marker for the early detection of myocardial ischemia with a potential prognostic value. Objective: The EDICA clinical trial assessed the performance of ApoJ-Glyc as a biomarker for the early detection of myocardial ischemia in patients attending the A&amp;E department with chest pain suggestive of acute coronary syndrome (ACS) and investigated -as a secondary pilot objective- its prognostic value. Methods: EDICA -a multi-centre, international, diagnostic study (NCT04119882) assessed 404 patients. Based on clinical variables and diagnostic tests, 291 patients were considered to have had a “non-ischemic” event and 113 an “ischemic” event. Blood samples were obtained for the assessment of high-sensitivity troponin and ApoJ-Glyc at admission and at 1h and 3h thereafter. GRACE Risk Score was calculated in all ischemic patients. Patients were followed up for 6 months after presentation and the occurrence of MACE (cardiac death, recovered cardiac arrest, re-infarction, cardiac failure, new admission for ACS after discharge, or unplanned revascularization for cardiac ischemia after discharge) was recorded. ApoJ-Glyc serum levels were analyzed with a novel ELISA targeting a specific glycosylated variant of ApoJ (ApoJ-GlycA2). Results: Among the patients in the ischemic group, 8.8% had MACE at 6-months and these showed a 26% mean reduction in ApoJ-GlycA2 levels 3h post-admission compared with levels at presentation. This reduction was not observed in patients without MACE. Patients in the highest GRACE Risk Score tertile (&gt;118 points) showed a progressive decrease in ApoJ-GlycA2 levels after presentation compared with patients in the lower risk tertiles (mean decrease: 41% at 1h, P=0.01 and 35% at 3h, P=0.02 when compared with admission levels). Conclusions: A progressive decrease in ApoJ-Glyc levels after A&amp;E admission appears to not only identify patients with ischemic events but also those at higher risk of suffering serious recurrent cardiovascular events at 6-months’ follow-up. Further studies in larger cohorts of patients are warranted to validate the potential role of ApoJ-Glyc in risk stratification in the context of cardiac ischemic events.
Abstract 12806: Attributable Mortality Benefit of Digoxin Treatment in Hypoplastic Left Heart Syndrome After the Norwood Operation
Authors: Michael L Obyrne, Lihai Song, JING HUANG, Bethan Lemley, Christopher L Smith, Jie Tang, Yoav Dori, Matthew J Gillespie, David Goldberg, Monique Gardner, Chitra Ravishankar, Jonathan Rome, Andrew C Glatz
Journal: Circulation (2022)

Introduction: Observational studies have demonstrated an association between digoxin treatment and lower interstage mortality after Norwood operation for hypoplastic left heart syndrome (HLHS), but the attributable mortality benefit has not been measureable without a clinical trial. Application of an instrumental variable can overcome confounding by indication and unmeasured confounding through pseudo-randomization. Methods: A multicenter retrospective cohort study of neonates with HLHS born 1/1/2007-12/31/2021, undergoing a Norwood operation at Pediatric Health Information Systems Database hospitals, and surviving &gt;14 days post-operatively was performed evaluating the association of digoxin and 1-year transplant-free survival. Traditional multivariable logistic regression models were supplemented with instrumental variable analyses using hospital-specific 60-day likelihood of administering digoxin. Results: The study population included 5,148 subjects treated at 47 hospitals (63% male, 46% non-Hispanic white); 44% (n=2,184) received digoxin. Receipt of digoxin was associated with superior 1-year transplant-free survival in unadjusted analyses (85% vs. 82%, p=0.02). This persisted after adjustment for measurable confounders (OR: 0.66, p&lt;0.001) and in an instrumental variable analysis (OR: 0.71, p=0.01, Figure). Conclusions: This observational study of patients with HLHS after Norwood used instrumental variable techniques to demonstrate a significant benefit in one-year transplant-free survival attributable to digoxin. In the absence of clinical trial data, this should encourage the use of digoxin in this vulnerable population..
Abstract 13482: Feasibility Analysis of a Nurse-Led Empowerment-Based Care Model in Supporting Treatment Decision-Making and Self-Care Among Patients With Atrial Fibrillation
Authors: Polly W Li, Doris S yu
Journal: Circulation (2022)

Introduction: Patients with atrial fibrillation (AF) play a passive role in the treatment decision-making process, rendering suboptimal medication optimization and poor self-care. This pilot study aimed to examine the feasibility and preliminary effects of a nurse-led empowerment-based intervention among AF patients. Methods: This study comprised a pilot randomized controlled trial and an exploratory qualitative phase. AF patients who had moderate to high risk of stroke but not receiving oral anticoagulation were recruited. Participants (N = 40) were randomized in 1:1 ratio to receive the intervention or standard care. The 13-week intervention adopted a novel behavioral activation approach to equip AF patients as an active agent to manage the disease. It consisted of care components to prepare patients for shared decision-making by using a decision aid, an empowerment-based educational module covering relevant AF self-care topics and continuous support through telephone calls. Ten participants in the intervention group attended a qualitative interview to explore their engagement experience and perceived feasibility. Results: The intervention was highly feasible and participants gave excellent rating for the satisfaction survey. The overall attendance rate was 82.5%. Compared with the standard care group, the intervention group showed greater improvements in health-related quality of life (HRQoL) [β = -10.617, (95% CI = -20.350 - -0.885), p = 0.033] and AF knowledge [β = 1.950, (95% CI =1.026 - 2.874), p &lt;0.001] at immediate post-intervention. The effects on both outcomes sustained at 6-month follow-up time point. No significant between-group changes in medication adherence, anxiety and depression were detected. Participants in the intervention group were activated to raise their concerns about AF and its treatment with the attending doctors. The qualitative data highlighted the uniqueness of the empowerment process of the intervention in improving their knowledge and self-care behaviors. Conclusions: The empowerment-based nurse-led intervention is highly feasible and acceptable for AF patients. It improved HRQoL, AF knowledge and treatment decision making in AF patients. It did not increase anxiety and depression.
Abstract 13404: Novel Sized-Based HDL Subspecies Demonstrate Inverse Associations With Incident Vascular Events
Authors: Austin Deets, Kavisha Singh, Alvin Chandra, Parag H Joshi, Amit Khera, Salim S Virani, Christie M Ballantyne, James D Otvos, Robin Dullaart, Eke G Gruppen, Margery A Connelly, Colby Ayers, Anand Rohatgi
Journal: Circulation (2022)

Recent studies suggest that total high-density lipoprotein particle concentration (HDL-P) outperforms HDL cholesterol (HDL-C) in predicting atherosclerotic cardiovascular disease (ASCVD). Whether specific size-based HDL subspecies contribute to the atheroprotective effects of HDL-P remains unknown. Our objective was to assess size-based HDL subspecies for association with both incident myocardial infarction (MI) and ischemic stroke in a large, diverse cohort, expecting heterogeneous associations regarding subspecies and vascular endpoints. Participants without prior ASCVD enrolled in the Dallas Heart Study, MESA, ARIC, and PREVEND were included as a single pooled cohort (N=15,371). Seven HDL size-based subspecies were quantified by NMR (LP4 algorithm; H1=smallest; H7=largest). The primary adjudicated outcomes over an average of 8-10 years of follow up were first MI and first ischemic stroke. Cox proportional hazards models included traditional ASCVD risk factors (except HDL-C) and all seven HDL subspecies. As continuous variables, higher H1, H2 and H4 concentrations were associated with lower risk of MI (Panel A), whereas higher H2 and H4 concentrations were associated with lower risk of ischemic stroke (Panel B). The top vs bottom quartiles of H2 and H4 had 27-32% lower incidence of MI (HR Q4 vs. Q1 [95% CI]: H1 0.73 [0.58-0.91]; H2 0.69 [0.54-0.89]; H4 0.68 [0.54-0.86]) and no significant associations with ischemic stroke. Serial adjustment for HDL-C attenuated all associations with ischemic stroke. However, H1 and H4 retained significant inverse associations with MI adjusted for HDL-C (HR/SD [95% CI]: H1 0.88 [0.81-0.94]; H4 0.89 [0.82-0.97]). H1 (small HDL) and H4 (medium HDL), but no large subspecies, demonstrated inverse associations with MI in a large multi-ethnic pooled cohort. Next steps include assessment of interactions by sex and race as well as incremental clinical utility of H1 and H4 compared to both HDL-C and total HDL-P in predicting MI.
Abstract 12767: Sodium-Glucose Cotransporter-2 Inhibitors Are Associated With Lower Risks of Hospitalization for Heart Failure and All-Cause Mortality in Patients With Diabetes Mellitus and Cancer
Authors: Cho Han Chiang, CHO HUNG CHIANG, Cho Hsien Chiang, Kevin Ma, Chun-Yu Peng, HSIA yuanping, Chuan-Sheng Horng, CHENG-YING CHEN, Yu-Cheng Chang, Xin Ya See, Yuan-Jen Chen, Shih-Syuan Wang, Giselle A Suero Abreu, Linda R Peterson, Paaladinesh Thavendiranathan, Philippe Armand, Cheng-Ming Peng, Her-Shyong Shiah, Tomas G Neilan
Journal: Circulation (2022)

Introduction: Patients with cancer face a heightened risk of cardiovascular (CV) events and mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce CV events in at-risk patients and may possess antitumor effects. Therefore, we examined the effect of SGLT2i on CV events and mortality among patients with cancer and diabetes. Methods: This was a retrospective propensity score-matched cohort study conducted at two tertiary referral centers in Taiwan. We included all adult patients with type 2 diabetes mellitus diagnosed with cancer between January 2010 and December 2021. The primary outcomes were hospitalization for incident heart failure (HF) and all-cause mortality. The secondary outcomes were a composite of myocardial infarction, ischemic stroke, and cardiac arrhythmias, and serious adverse events associated with SGLT2i. Results: From a total of 8640 patients, 878 SGLT2i-recipients were matched to non-recipients. During a median follow-up period of 18.8 months, SGLT2i recipients had a lower rate of hospitalization for incident HF compared with non-SGLT2i recipients (2.92 vs. 8.95 per 1000 patient-years, p=0.018). In both Cox regression and competing regression models, SGLT2i were associated with a 70% reduction in the risk for hospitalization for incident HF (HR, 0.28 [95% CI: 0.11-0.77], p = 0.013; SHR, 0.32 [95% CI: 0.12-0.84], p = 0.021). The use of SGLT2i was associated with a higher overall survival (85.3% vs. 63.0% at 2 years, p&lt;0.001). The risk of myocardial infarction, ischemic stroke, cardiac arrhythmias, and serious adverse events such as hypoglycemia, urosepsis, and sepsis was similar between the SGLT2i and non-SGLT2i cohorts. Conclusions: The use of SGLT2i was associated with a lower rate of hospitalization for incident HF and prolonged overall survival in cancer patients with diabetes mellitus.
Abstract 13419: Racial Differences in Patients With Spontaneous Coronary Artery Dissection: A Report of the ISCAD Registry
Authors: Bryan J Wells, Esther S Kim, sahar naderi, Katherine Leon, C M Gibson, Gerald C Chi, Anna Grodzinsky, Heather L Gornik, Jennifer Lewey, Angela Taylor, Daniella Kadian Dodov, Connie N Hess, Stanislav Henkin, Kathryn J Lindley, Gretchen Morris, James L Orford, Lori M Tam, Dharam J Kumbhani, Samuel Norris, Cassandra Reyes, Fahad Alkhalfan, Clara Vitarello, Andrea Martinez, Malissa Wood
Journal: Circulation (2022)

Introduction: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction. The demographics and clinical differences based on race in patients with SCAD are not well understood. Methods: Demographics and clinical variables were obtained from the prospective, multicenter iSCAD Registry. Characteristics of study participants (including demographics, past medical history, timeline, imaging studies, follow-up visits, SCAD presentation, and treatment) were compared between white and non-white patients. Race and ethnicity was self-reported by a patient questionnaire. Results: A total of 505 patients were included in the analysis. Among them, 427 (84.6%) were characterized as white and 78 (15.4%) were characterized as non-white. White patients were 49.5 years and non-white patients were 46.8 years at the time of the initial SCAD presentation (p=0.0435). White patients were more likely to be married (77% vs 51%, p&lt;0.0001) and were more likely to have a college degree (42 vs 28%, p&lt;0.0001). White patients were more likely to present to the hospital in less than 24 hours (85% vs 75%, p=0.07) and have an angiogram in less than 24 hours (78% vs 58%, p=0.004). White patients were more likely to present with STEMI (30% vs 11%, p=0.004) and were more likely to receive revascularization (25% vs 11%, p=0.0147). A multivariable analysis explored the variables associated with angiography greater than 24 hours. STEMI vs NSTEMI [OR 0.090 (0.035 to 0.231), p&lt;0.0001] and white vs non-white [OR 0.376 (0.188 to 0.755), p=0.0059] remained significant. White patients were more likely to have fibromuscular dysplasia (FMD), (43% vs 30%, p=0.0336). There was no significant difference in the number of non-coronary vascular imaging studies between the two groups. Conclusions: The number of non-white patients enrolled in the iSCAD registry is low. White patients with SCAD were more likely to present with STEMI and were more likely to have a diagnosis of FMD. Further research is needed to study associations between race and differences in presentation, comorbidities, and treatment in patients with SCAD.
Abstract 14070: Role of Early Aortic Valve Replacement versus Conventional Management in Asymptomatic Patients With Severe Aortic Stenosis: A Meta-Analysis
Authors: Arpanjeet Kaur, arshdeep dhaliwal, Sumit Sohal, Yoni Balboul, Jacqueline Tamis-Holland
Journal: Circulation (2022)

Introduction: Aortic-valve replacement (AVR) is an effective therapy for patients with severe symptomatic aortic stenosis (AS) but the appropriate timing of intervention for asymptomatic patients with severe AS remains controversial. Increased mortality associated with the onset of symptoms challenges the conventional “watchful waiting” strategy followed for this subset of patients. An early intervention may be warranted, however the data supporting this hypothesis is small. Our aim was to perform meta-analysis looking at outcomes of early surgical AVR (SAVR) in asymptomatic severe AS patients with preserved LVEF. Methods: Electronic databases were searched for studies comparing early SAVR and conventional treatment in patients with asymptomatic severe AS and normal LV function. The primary outcome of interest was all cause mortality. Secondary outcome was heart failure hospitalization. Random-effects model was used to estimate the pooled risk ratio (RR), and 95% confidence interval (CI) using Revman 5.4.1. Subgroup analysis stratified by study design was performed. Heterogeneity was assessed by Higgins I 2 statistic. Results: We found total of 8 studies (2 RCTs; 6 observational) from which 2669 patients with asymptomatic severe AS were identified. 1354 underwent SAVR and 1315 were managed conservatively. The mean age was 68 years with mean follow up duration of 4.8±2 years. There was statistically significant reduction in all-cause mortality (RR: 0.37; CI: 0.27-0.50; p&lt;0.05; I2 = 68%) and heart failure hospitalization (RR: 0.24; CI: 0.16-0.36; p&lt;0.05; I2 = 0%) among patients who underwent AVR compared with conservative treatment with subgroup analysis by study design showing similar trends. Conclusion: Our meta-analysis shows that compared with conventional treatment strategy, early SAVR in asymptomatic patients with severe AS is associated with improved long-term outcomes notably reduced all cause mortality and heart failure hospitalizations.